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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEII'ARATION I lF.t, rrm un& psdry of ,qury rhd I m .rd9l nom dr codrrlon ljc.e tt* aor rhc 6ll6srB la$n (Sd70!l5 Blsrnd lrd Profd6. co&) A.y ( n) .. ( oudy whi(h r.quir6 ! rE ir ro otErrucl. .1t6. inFoB danoliih oi E?.n &y irrudm, Fi,r to ir3 isue.. .Lo rtqoic rh. ippl(a for ruch Fhir ro lil.. rQn d ,dmd rfii lE or nE i [..c] pu'd io lh. Fovni]B oa dE Conl'rio! l-ia!.d ll* lcrupio 9. ( omddcir8 *hh S.dir. 7m0 of Divirion I ofrn B6ils ed Prcf*68 Con ) ( lhd lE or sh. n .rdn'l rh<lnoo dd tl'. ta. fn 0E rlk!.d .ronFioi Any liohiion olsclbn 701 I 5 h ty q,gl'cul ao! i F6rn sii..ls lh. .p?licul lo . .ivil p.Mh y o I ml nor. rhm nv. hurH &ller (t300) Laowofrn.FDtEi),orm,mpLt6withw.a6alhd$1.NnFsi4$ill.bfi.*dl-dth.rM@i!mr hldll.l or olld.d ror st.156 ?Ola. BUi6 ed Pref6i'6 Cod.' Ttc Colr6doi3 l.r.e is &E lnr +dy lo ! otr€ of rh. FnFq wr. bil& 6 hymr- tlE6( od sh. d.6 ndr *qi hlelf or hdel f or thmuSh hit or h6 om @plor6. Fovd.d rh.l s.h imFovdEii! E m| haxbd or olIa.d for &b l( ho$Bd. rlE tlildrs or ,rB.$at a&ld*ihnorcra ofcdrprai\ {EOsE Uuilb win hr. E h,rto!.f prortrB tlq lE d !r. dd mt &ild or mFor! ttr FoFq ftr tlr FrFrof l. co*cotlh. Fopslr. crclarv.l! co.'lnclir8 $ith licdlr.dco'nrr.loElo cotrrrucl llE rlFl (56 1X!, tllliK&l Pnrarn Codn: Ttc ( onraloi.r Li.@ tr* dB nor rrply ro d ow.d o rlrnFn, $ho blild! or impb\ g rh6on, r.{ rib c.'lr&rt fo,3uch Ir jrrrs $nh ! Colrtuo(s) lic.E d pos@ ro rh. ftdldor! liff lls). ,,","i'rytolA I t(.h' lmmund6 ,.nrlr) olpaiurr on.olth. nnh$ I h.r. ri $ ill m!d.f ! ( dr lk.r. of coBdr t. s.lf lNur. lir snrk6' nurrM ($. a Fovid.rl lor ht Sd i.. t7(n oarh. l,lrt(od( rorlh.psrome.-cotll<rort lorshrhlh.Frnil it isuc{ I hlrc rnd $ ill m.n .i. sorl6 corrENlio. iNuranc.. 6 r.quir.il b snlin :t 7(xr of 0E l,t{. (-orL. aor rh. Ff(lffi of lh. *.r! tu uhich thir Fnnn it is.d M, \vl6 ohFMio. iNurM...6id rd rElat nlmb.r E I cdi6lh.l i. lh. Fn'lrm. of(hc "orl lor*nrhihnFnn ir irsaL I rh.ll6r @pl.v rry pdsn in.n) mdE $ 6 to tEroN Ntixr ro rlE *dtd'sdFBdhn h*r orc.Iaomia an 4R tlll ill rh.lld b.(oE n'bjd ro tlEq.rlc' .ontosto. prc{lionr ol sdr^ I7o0 ollh. Lrhx ( dq I dult. fonhrith sq,l} u hh r}nE Fo}i'io6 I\ARNINCT [.ilur.lo su. rsl6' comFeli.n olqrr. ir onL$tu1. ..d 3h.]l sbjd 6 dpLF !o dimiMl Frib arl .ivil th6 ur, lo oc hudr.d lhousd &lhF ItlO0.000). in .ddnion ro thc .or of onp.Blim, d&rs6 E rmvid.n lo. rh. Sdi)n.ro7adarh. trhtr Cod., dd.3 rnd nl{rE} 3 f6. DE(]dAAIIO! I H, lrrm uodd I'.nilty of Fjury lhn I m licrel ur*r tmrisirn of('i.I)ra I (com@in8 $nh Sdhn 70(x)).lDnLlhn r of rfi. Bsin6 rnd Poaoi,N Cod.. rn ny lads ii in foll fo(. ed .ft t cqltrSl{:Ilol.LEll)lxqlgEll} I hfthy lmm und6 Frliy of Fjury lhd llE ir.odrudhn Efrlin8 4fty for tlE Ff.xrluc of lhc wort fo,qh(hlh6lEnil it i$.d (S<. 1097.Civ C ) AIEI!(AILDESJAAIIAN I hd6y .rm u,rdc F dl, of Fjury on. .t rlE lollowirB &!h..rioN: D.mnnbn P@ir.Arb6rot Nori6.die. F.d6rl R.ruLrbB (TnL 40. Pdr6) R.!!n!d l-c6of tlotilarbn I cdr,6 rhd rh. r6j.ralr.rubxoc r.s{d'nB 6h6tus rmMI s. mr 4FlicabL t( rhr Droj.< I.dia) rnd I hrE ran rtu 6pplicarion Md 3ra.tht rh. !ho\. inforrdir. ir c.r<' I .sc ro cooply $(h a! Cn, r.d countr ordiMnc6 and srlrc L.*. Eld i.s ro hritli,s codtu.rir( dd hsq.- iurhorn. qrer.li6 o nh! Cnt dd Coumt ro drc otbn rlE ,r!\r trn r{r,r lfl rn\ r, n,\lv,r rppli.inr or rs6,r Slsn ur / \ Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenVl nsulation Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif IF|NAL /t l2ttlq trLdrt)0q' Certificate of Occu pancy Notes, Remarks, Etc.